Public Awareness and Knowledge of Sleeve Gastrectomy in the Southwest Region of Saudi Arabia

Background Obesity is a major global health concern, causing significant health dilemmas. Large groups of Saudi individuals are considered obese, with significant implications for medical practice. Bariatric surgery, including sleeve gastrectomy, is a crucial intervention for severe obesity, although it is associated with potential complications. This study aims to investigate the public knowledge about the indications and consequences of sleeve gastrectomy in the Southwest region of Saudi Arabia and assess their general awareness of sleeve gastrectomy. Methodology This descriptive, cross-sectional, online-based study included 347 individuals from the Southwest region of Saudi Arabia. Data were collected via an online questionnaire and analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results This study included 347 participants, with a majority being females (88.5%, n = 307) and Saudis (98.6%, n = 342). The most common age group was 21-25 years (34%, n = 118), followed by those over 40 years of age (26.5%, n = 92). Most participants resided in Al-Qunfudhah (66.3%, n = 230) and held a bachelor’s degree (75.8%, n = 263). Nearly half were students (48.7%, n = 169), and 56.2% (n = 195) earned less than 5,000 per month. The prevalent weight range was 40-60 kg (46.1%, n = 160), and most participants’ height was 150-160 cm (58.5%, n = 203). Overall, 61% (x̄ = 211.6) of the respondents had good knowledge about sleeve gastrectomy, with 70.3% (x̄ = 244) understanding its general aspects, 56.1% (x̄ = 194.5) knowing the indications, and 60.1% (x̄ = 208.7) aware of the complications. Conclusions The majority of residents of the Southwest region of Saudi Arabia have moderate levels of knowledge regarding sleeve gastrectomy. However, the study demonstrated substantial gaps in knowledge and awareness regarding sleeve gastrectomy, mainly about its indications and potential.


Introduction
Obesity has emerged as a significant global health challenge in recent years [1], constituting the most prevalent metabolic disorder attaining epidemic proportions across both developed and developing nations [2,3].As of 2016, approximately 13% of the global adult population was affected by obesity, with rates of 15% among women and 11% among men [4].
In Saudi Arabia, obesity is one of the major health concerns affecting both genders, with more than 35% of the population being obese [5,6].As a result, several affected individuals seek metabolic bariatric surgery (MBS) without previous knowledge of the indications and its consequences.As they can be drawn and influenced by other people or media advertisements, it is important for them to understand and be aware of this topic and its indications.Addressing obesity necessitates a systematic approach.Initially, all patients should prioritize lifestyle modifications and behavioral therapy.Pharmacological interventions represent the second line of management.MBS constitutes the third-line treatment, acknowledged as a highly efficacious and enduring intervention, particularly for severely to moderately obese individuals who show inadequate response to non-surgical modalities [3].Apart from sustainable weight loss, MBS demonstrates optimal glycemic control, leading to diabetes remission [7].
Specific guidelines for MBS must be meticulously observed, which vary by procedure type [8,9], with sleeve gastrectomy emerging as the predominant procedure.Sleeve gastrectomy is efficient not only due to its restrictive nature but also because of the removal of the gastric fundus which leads to lower ghrelin levels, reduced appetite, and weight loss [10,11].Despite its efficacy, this procedure carries potential complications, some of which are life-threatening [12].Major complications include leaks and hemorrhages [13].
In Saudi Arabia, indications for sleeve gastrectomy encompass adults with a body mass index (BMI) of 30 kg/m² or greater, particularly those with poorly controlled type 2 diabetes and heightened cardiovascular risk, adults with a BMI of 35 kg/m² or greater presenting severe comorbidities, or adults with a BMI of 40 kg/m² or greater [17,18].
Although various studies have explored the landscape of obesity and sleeve gastrectomy across Saudi Arabia, to date, no investigation has focused specifically on the Southwest region.Thus, the objective of this study is to enhance our comprehension of public awareness and knowledge regarding sleeve gastrectomy in the Southwest region of Saudi Arabia.A recent nationwide study conducted by ) with a mean age of 37.5 years.Awareness rates were 49% for indications and 82.4% for complications, with knowledge significantly associated with awareness of BMI.The study found high awareness of sleeve gastrectomy (99.1%) among the participants, with 60.9% aware of indications and 72.2% of complications.Knowledge levels were higher among those aware of BMI [22].
Lastly, Al Watban et al. explored awareness among 480 participants in Riyadh in 2020, with a majority male (51.5%) and educated up to bachelor's level (52.7%).While awareness of BMI was limited (16.7% knew the correct obese BMI levels), awareness of sleeve gastrectomy complications was higher (64.8%), correlating with educational level [23].
Therefore, this study aims to fill the research gap in the understanding of the public awareness and knowledge of sleeve gastrectomy in the Southwest region of Saudi Arabia, as, to our knowledge, no studies have been conducted in this region to assess this concern.

Study design
A descriptive, cross-sectional, online-based study was conducted in the Southwest region of Saudi Arabia by utilizing a structured self-administered online questionnaire targeting the general population in the region.

Study objective
The objective of this study was to assess the level of public knowledge about the indications and consequences of sleeve gastrectomy in the Southwest region of Saudi Arabia and assess their general awareness of sleeve gastrectomy.

Inclusive criteria
Male and female adults, aged 18 years and more, living in the Southwest region of Saudi Arabia who accepted to participate in this study were included.

Sample size
Sampling was done based on the convenient sampling method with an expected sample size of 347 according to Raosoft calculation taking into consideration a 5% margin of error and a 95% confidence interval.

Data collection tools
The data were collected through an online questionnaire using e-mails and other social media platforms including WhatsApp, X, and Telegram.A cover page that illustrated both the purpose of the study and participant consent was used.The questionnaire included four sections.The first one included the sociodemographic characteristics of the participants such as gender, age, body weight, and height.The second section included five questions to assess the general knowledge of participants.The third section contained seven questions to assess the knowledge regarding the indications of sleeve gastrectomy.The fourth section included nine questions to assess the knowledge of participants regarding the complications of sleeve gastrectomy.

Data analysis
After obtaining consent to conduct the study, the data were collected and computerized using Microsoft Excel (Microsoft Corp., Redmond, WA, USA) to form a database using all the items from the data collection sheets.Data were then encoded and analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA).Data are displayed and presented in the form of tables and charts.

Ethical considerations
Ethical approval was sought from Umm Al-Qura University (approval number: HAPO-02-K-012-2024-02-2021) before starting the study.The objectives and benefits of the study were explained to the participants.Confidentiality and privacy of the participants were maintained.The participants had the right to withdraw consent at any time without any consequences.

Discussion
This study aimed to assess the knowledge and awareness of sleeve gastrectomy indications and complications among residents of the Southwest region of Saudi Arabia.Several studies conducted across different regions of Saudi Arabia have examined similar themes, contributing valuable insights to the existing literature.
Our study found that the overall level of knowledge among respondents regarding sleeve gastrectomy was moderate.Specifically, a substantial proportion exhibited good general knowledge about sleeve gastrectomy, with a majority showing familiarity with its indications and potential complications.These findings underscore the importance of education and awareness initiatives to further enhance understanding among the general population regarding this surgical procedure.
A recent study by Taha et al. involving a substantial sample of 1,013 participants reported a high awareness rate of sleeve gastrectomy (97%) among Saudi Arabian residents.The majority of participants demonstrated awareness of BMI (68%), and a significant proportion were familiar with the complications associated with sleeve gastrectomy (81%).However, only 53% of participants accurately understood the indications for sleeve gastrectomy [19].
Similarly, Buhalim et  The study showed nearly universal awareness of sleeve gastrectomy (99.1%) among participants, with 60.9% correctly identifying indications and 72.2% understanding complications.These findings were somewhat higher than those observed in this study, suggesting potential regional or demographic differences [22].
Conversely, Al Watban et al.'s 2020 study in Riyadh revealed lower overall awareness levels and a lack of knowledge about sleeve gastrectomy indications (59.0%) among participants.This study highlighted potential educational disparities and the need for targeted educational interventions [23].
Overall, these studies collectively underscore the ongoing need for comprehensive public education and awareness campaigns regarding sleeve gastrectomy indications and complications across Saudi Arabia.
Variations in findings may be attributed to differences in study populations, cultural contexts, and regional demographics, emphasizing the importance of tailored approaches to improve knowledge and understanding among potential candidates and the broader public.

Recommendations
Healthcare providers should work on increasing public awareness about sleeve gastrectomy.Proper counseling should be provided to patients, explaining the indications and possible complications of sleeve gastrectomy.Social media can play a bigger role in raising knowledge and awareness about sleeve gastrectomy.More studies regarding this topic should be conducted to support the evidence and raise knowledge and awareness levels.

Limitations
The study was conducted using a blind methodology on a general population sample without limiting the focus to individuals with specific diseases.Due to the lack of access to bariatric surgery clinics for direct interviews with affected participants, data collection relied on online questionnaires.

Conclusions
The majority of residents in the Southwest region of Saudi Arabia had moderate levels of knowledge regarding sleeve gastrectomy.However, the study demonstrated substantial gaps in knowledge and awareness regarding sleeve gastrectomy, mainly about its indications and potential complications.It is essential to raise the general public's knowledge and awareness about the indications and complications of sleeve gastrectomy.

TABLE 4 : Overall knowledge of respondents regarding sleeve gastrectomy.
x̄: statistical mean